Do not write in this space – (Office Use Only)

Order ID:  IS-

(Please Use Dark Ink. No staples or tape on form)

 

Contact Information:      Order Form

Phone:

Email :

 

* Enter Your Name & Shipping Address:

 

 

Mail Service: (Use Address Below)

Send order form with payment to:

Internet Smokes

PO Box 40

Irving, NY 14081
Your Personal Check or Money Order Welcome

 

USPS Priority Mail Rates:
Up to 3 Cartons: $11.15 - 4 to 6 Cartons: $13.40 – 7 to 9 Cartons: $18.70
 10 Cartons: $20.70 – Additional Add $2.00 Per Carton

 

BRAND

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Special Instructions:

Fast and Fresh!
Thank you

Sub Total

$

Shipping -

(See Above)

$

TOTAL

$

 

1. Age Verification: (Required By Law):  Existing Customers: Sign your name below.

 New Customers: Sign your name below and send in a COPY of State issued ID (i.e. Drivers License)

I Certify that I and anyone I am ordering for are over my State’s Adult Legal Age: YES

___ Enclose Check or Money Order or

Enter Credit Card Information Below:
We Accept: ___ MasterCard ___Visa ___Discover

____ ____ ____ ____ - ____ ____ ____ ____ - ____ ____ ____ ____ - ____ ____ ____ ____

Expiration Date: ____ / ____   Enter CVV
(3 Digit Code) ____ ____ ___

I authorize you to charge my credit / debit card:

Sign Here:  __________________________________________________________________

                 Visit us on the web: InternetSmokes.com